SIGA Saúde São Paulo City s Health Information System

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1 SIGA Saúde São Paulo City s Health Information System Beatriz de Faria Leão, MD, PhD Lincoln A Moura Jr, MSc, DIC, PhD Cláudio Giulliano Alves da Costa, MD

2 SIGA Saúde SIGA Saúde is São Paulo City s Integrated and Distributed System for Managing the Public Healthcare System. The system belongs to São Paulo City, which is willing to share it with other cities, states and countries. SIGA Saúde has been developed using free-software open-code concepts. São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area. Initial Figures: 400 Primary Care Units 60 Polyclinics 160 Hospitals SIGA Saúde is present in 100% of 11M Users São Paulo City public health care providers 8.5M Emergency T/year 550k Inpatients/year 11M Primary Care C/year 2

3 Volumes per Region in the City East Region South Region Casa Verde Freg/Brasilandia Perus Pirituba Santana Tremembe/Jacana V Maria/V Guilherme CenterEast Region Sé Population: 2,136,977 Butantã Lapa Pinheiros Population: 1,244, million patients in the database South Region Campo Limpo Cidade Ademar Boi Mirim Parelheiros Socorro Sto Amaro Population: 2,402, Tiradentes E. Matarazzo Guianases Itaim Paulista Itaquera São Mateus São Miguel Population: 2,396,940 Aricanduva Ipiranga Jabaquara Mooca Penha V Mariana V Prudente Southeast Region Population: 2,499,

4 Before SIGA Saúde Access to health services was difficult: long waiting lines for specialized procedures and consultations No integration among health care providers No control of medication distribution Very little information for health care management 4

5 SIGA Saúde Building Blocks Identifying Patients Based on Unique Nation-Wide Patient Identifier Captures Encounter Data Set On-line Access to Patient Information National Registry of HC Units and Workers Unique Nation-wide Identifiers: Healthcare Workers, Units & Medical Equipment Relationships Among Them Concepts, Policies & Norms Health Promotion / Prevention Emphasis on Primary Care Family Health Program National Immunization Program Patient Flow Organization and Control Agreed Reference-Counter-Reference Model Municipalization of Care on a Capitation Basis Automatic Electronic Disease Notification Ability to be Intelligent 5

6 Primary Care Units in São Paulo 6

7 Ensuring Equity and Integrality of Care axes Patient Flow Organization & Control High Complexity - Hospitals Electronic Health Record Counter-reference Polyclinic Private Hospital Diagnostic Center University Hospital regionalization Specialties Public Hospital Reference Diagnostic Center Reference Medium Complexity Physician Office Primary Care Unit Physician Office Physician Office Primary Care Unit Primary Care Unit Entry Level Primary Care 7

8 SIGA Saúde Conceptual Model Nacional Registry Domain Tables and Vocabularies R ol ol Hospitals and Healthcare Units HC Workers Users (Patients) e -- b Emergency Primary Care Electronic Health Record Specialties Inpatients Exams a s e d A cc cc e ss ss Flow Control HC Services Management Assessment C on on Consultations Beds Exams Emergency Authorization Health Surveillance Billing Auditing tt rr o ll 8

9 Regulation of High-Complexity Exams Private Hospital University Hospital Public Hospital Polyclinic Diagnostic Center Specialties Diagnostic Center Physician Office Primary Care Unit Physician Office Physician Office Primary Care Unit Primary Care Unit Regulation Center Entry Level Entry Level Configuration HC Services Grid Limits (Amounts & Values) General Parameters Clinical Breadth HC Units Regulating Agents $$$ from Agreement Physical Limits Município Município Estado Requesting HC Units Distribution According with Complexity Level Execution Limits Município Município Município Município Município Executing HC Units Authorization Requesting Limits 9

10 SIGA Saúde IT Model SMS-SP Management (Surveillance, Auditing and Billing) Dept of Health Internet Patient Flow Organization & Mngmnt (Specialties, Beds, Exams) Electronic Health Record SP City Datacenter Access Access Control Control 10

11 SIGA SIGA Saúde Saúde Deployment DeploymentStrategy Adm / Manag. DSS Health Information Medical Images HIS Auditing Lab Integration EHR Surveillance Medication at Home Authorization processing of high-cost, high-complexity procedures Medication Scheduling Specialized Consultations Scheduling Capturing Encounter Information 2004 HR capacity Infra-structure National Health Patient Registry National Health Care Providers Registry

12 Opening Screen in

13 Opening Screen in June,

14 SIGA Saúde: Querying Services Quota 14

15 15

16 Geo-referencing Using Google Earth API 16

17 Encounter Data Set Type of Attendance Special Programs Anamnesis, Physical Exam, History Diagnosis Disabilities Procedures carried-out Requested procedures Medications Course of Action Work-Related Diseases Communication Form Notifiable Diseases High-Complexity Procedure Order Form 17

18 Notifiable Diseases Report 18

19 e-authorization Processing Evolution of electronic and paper-based ordering and authorization processing of high-cost, high-complexity procedures from January/2005 to March/ Orders/month Jan Fev M ar Abril M ai Jun Jul Ago Set Out Nov Dez Jan Fev M ar Abril M ai Jun Jul Ago Set Out Nov Dez Jan Fev M ar Manual / Paper-based Electronic 19

20 SIGA Saúde Figures for May, ,301,383 registered users 1,017,463 primary care scheduling / month 189,393 specialized care consultations / month 1,738,807 medical prescriptions attended over the counter / month 35,000 authorizations of high cost & complexity procedures / month 30% reduction in the waiting time for specialized consultations & procedures Medication available at local pharmacies - supply chain control 20

21 SIGA Saúde: Who Is Using the System (June, 2008) São Paulo City 700 health care providers Focus on Patient Flow São Paulo State 28 Cities share the system for Hemodialysis and Hemophilia Camaçari, BA Small City near Salvador (Bahia State) 250,000 inhabitants, 32 Primary Care Units Focus on EHR, Medication Dispensing, and Billing Campinas,SP City 100km from São Paulo 1.5 million inhabitants, 50 Primary Care Units Focus on EHR and patient flow 21

22 SIGA Saúde: Project Timeline January contract was signed September First deployment : 700 heath care providers connected Medication control and patient scheduling 100% of HC providers Authorizations of high cost / complexity procedues: 100% electronically Special programs data capture São Paulo city women/child program Lab results integration under development Investment US$ 10M Software US$ 50M Hardware, Connectivity Training 15,000 health professionals trained 22

23 Very Tight Initial Schedule Despite the odds, the system was delivered on time Quick development vs. high quality in a short time (~ 4 months) Contract Signed First Use Cases Specified Deployment Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Team Assembled Development New Features 23

24 SIGA Saúde Development Strategy: Key Issues Well-defined software development process Component-driven software development Well-defined project guidelines and coding standards Continuous integration Strong project management Knowledge sharing 24

25 SIGA Saúde Technical Strategies Use of open standards and open source paradigms Based on Java / Java EE Three Tiers presentation, business and persistence Linux Web based Thin Clients at the point-of-care Database independence 25

26 SIGA Saúde Technical Strategies HTML WEB Container Application Server EJB Container Session Façades Entity Beans Service Classes and SLS Beans Utility Classes Database 26

27 SIGA Saúde Project Management Well-defined issues tracking process, using a web-based tool for managing all project tasks; All project members had real time visibility of what was going on in the project; When new tasks were created, delays happened or tasks were finished, an was automatically generated informing the person responsible for the task; This technique gave us important metrics that helped to keep the project within schedule and improved the communication among the team members. 27

28 SIGA Saúde Project Management 28

29 SIGA Saúde Proven Benefits Patient Flow Organization & Control Supports the Reference-Counter-Reference Model Finds the Shortest & Most Resolving Way Through the HC System Manages & Operate the Whole Health System Identifies all HC Units, Workers & Their Relationships Uniquely Understands and Qualify the Demands Connecting the Health System Connects Internal & External Units & Functions Reduces Costs & Increases Productivity HL7 v3.0 Project to Connect Accredited Labs to SIGA Saúde The Electronic Health Record Identifies each Individual / Patient Uniquely Knows the Patient s Clinical History Helps Healthcare Workers do their Job (Decision Support) Still Many Things to Do Hospital Information Systems + Full EHR Further Improve the Clinical Content with Archetypes 29

30 SIGA Saúde: Advantages of the Architecture Several cities can share servers and services; Simple machines at the point of care; No need for computer personnel at healthcare units; Complexity stays away from the user, under central control; Model can be rolled out to other places; New functionalities can be added easily; SIGA Saúde: Periodic Updates 30

31 Next Steps for SIGA Saúde Full EHRS On-line lab reports: 8 labs using LOINC + HL7 v3 content + Brazilian national schemas for interoperability operational in Sep 2008 Municipal Hospitals IT Project Health Information for the Citizen Empowering the patient Distance Learning TeleHealth 31

32 From Archetypes to the EHR System Archetype processing Engine Items of Interest BP Archetype Automatically creates screens and data structures Open Software 32

33 From Archetypes to the EHR System Archetypes EHRS Screens and Forms 33

34 Thanks!! Questions? Cláudio G A Costa, MD CIO São Paulo City Dept of Health Phone #: Beatriz de Faria Leão, MD, PhD Av. Eng. Luis Carlos Berrini, 962 cj São Paulo, SP, Brazil Phone #: Fax #:

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